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1. Obesity-associated microbiomes instigate visceral adipose tissue inflammation by recruitment of distinct neutrophils

Author

Dharti Shantaram, Rebecca Hoyd, Alecia M. Blaszczak, Linda Antwi, Anahita Jalilvand, Valerie P. Wright, Joey Liu, Alan J. Smith, David Bradley, William Lafuse, YunZhou Liu, Nyelia F. Williams, Owen Snyder, Caroline Wheeler, Bradley Needleman, Stacy Brethauer, Sabrena Noria, David Renton, Kyle A. Perry, Prabha Nagareddy, Daniel Wozniak, Sahil Mahajan, Pranav S. J. B. Rana, Maciej Pietrzak, Larry S. Schlesinger, Daniel J. Spakowicz, and Willa A. Hsueh

Subjects
Science
Abstract

Abstract Neutrophils are increasingly implicated in chronic inflammation and metabolic disorders. Here, we show that visceral adipose tissue (VAT) from individuals with obesity contains more neutrophils than in those without obesity and is associated with a distinct bacterial community. Exploring the mechanism, we gavaged microbiome-depleted mice with stool from patients with and without obesity during high-fat or normal diet administration. Only mice receiving high-fat diet and stool from subjects with obesity show enrichment of VAT neutrophils, suggesting donor microbiome and recipient diet determine VAT neutrophilia. A rise in pro-inflammatory CD4+ Th1 cells and a drop in immunoregulatory T cells in VAT only follows if there is a transient spike in neutrophils. Human VAT neutrophils exhibit a distinct gene expression pattern that is found in different human tissues, including tumors. VAT neutrophils and bacteria may be a novel therapeutic target for treating inflammatory-driven complications of obesity, including insulin resistance and colon cancer.

Published
2024
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2. Interferon gamma mediates the reduction of adipose tissue regulatory T cells in human obesity

Author

David Bradley, Alan J. Smith, Alecia Blaszczak, Dharti Shantaram, Stephen M. Bergin, Anahita Jalilvand, Valerie Wright, Kathleen L. Wyne, Revati S. Dewal, Lisa A. Baer, Katherine R. Wright, Kristin I. Stanford, Bradley Needleman, Stacy Brethauer, Sabrena Noria, David Renton, Joshua J. Joseph, Amy Lovett-Racke, Joey Liu, and Willa A. Hsueh

Subjects
Science
Abstract

Murine models of obesity suggest that decreases in the adipose tissue regulatory T cell compartment may contribute to insulin resistance, but how this corresponds in the human clinical context is less well understood. Here the authors propose a role for interferon gamma in shrinking the adipose tissue regulatory T cell compartment seen in human obesity and assess the alterations seen during induction of dietary changes.

Published
2022
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5. Interferon gamma mediates the reduction of adipose tissue regulatory T cells in human obesity

Author

David Bradley, Alan J. Smith, Alecia Blaszczak, Dharti Shantaram, Stephen M. Bergin, Anahita Jalilvand, Valerie Wright, Kathleen L. Wyne, Revati S. Dewal, Lisa A. Baer, Katherine R. Wright, Kristin I. Stanford, Bradley Needleman, Stacy Brethauer, Sabrena Noria, David Renton, Joshua J. Joseph, Amy Lovett-Racke, Joey Liu, and Willa A. Hsueh

Subjects
Multidisciplinary, Programmed Cell Death 1 Receptor, General Physics and Astronomy, Mice, Obese, General Chemistry, T-Lymphocytes, Regulatory, General Biochemistry, Genetics and Molecular Biology, Mice, Inbred C57BL, Interferon-gamma, Mice, Adipose Tissue, Animals, Humans, Obesity, Insulin Resistance
Abstract

Decreased adipose tissue regulatory T cells contribute to insulin resistance in obese mice, however, little is known about the mechanisms regulating adipose tissue regulatory T cells numbers in humans. Here we obtain adipose tissue from obese and lean volunteers. Regulatory T cell abundance is lower in obese vs. lean visceral and subcutaneous adipose tissue and associates with reduced insulin sensitivity and altered adipocyte metabolic gene expression. Regulatory T cells numbers decline following high-fat diet induction in lean volunteers. We see alteration in major histocompatibility complex II pathway in adipocytes from obese patients and after high fat ingestion, which increases T helper 1 cell numbers and decreases regulatory T cell differentiation. We also observe increased expression of inhibitory co-receptors including programmed cell death protein 1 and OX40 in visceral adipose tissue regulatory T cells from patients with obesity. In human obesity, these global effects of interferon gamma to reduce regulatory T cells and diminish their function appear to instigate adipose inflammation and suppress adipocyte metabolism, leading to insulin resistance.

Published
2021

7. SAGES rebuttal

Author

Daniel B, Jones, John G, Hunter, Courtney M, Townsend, Rebecca M, Minter, Patricia L, Roberts, Stacy, Brethauer, and Nathaniel J, Soper

Subjects
03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Gastroenterology, 030211 gastroenterology & hepatology, Radiology, Nuclear Medicine and imaging, Clinical Competence, Endoscopy, Gastrointestinal
Published
2017

8. Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass

Author

Joshua P, Landreneau, Andrew T, Strong, John H, Rodriguez, Essa M, Aleassa, Ali, Aminian, Stacy, Brethauer, Philip R, Schauer, and Matthew D, Kroh

Subjects
Adult, Reoperation, Treatment Outcome, Gastrectomy, Gastric Bypass, Humans, Middle Aged, Obesity, Morbid, Retrospective Studies
Abstract

A subset of patients undergoing laparoscopic sleeve gastrectomy (SG) require eventual conversion to Roux-en-Y gastric bypass (RYGB) due to complications from SG or to enhance weight loss. The aim of this study is to characterize the indications for conversion and perioperative outcomes in a large cohort of these patients at a single institution.Patients who underwent revisional surgery to convert SG to RYGB at our institution from January 2008 through January 2017 were retrospectively reviewed.Eighty-nine patients with previous SG underwent conversion to RYGB as part of a planned two-stage approach to gastric bypass (n = 36), for weight recidivism (n = 11), or for complications related to SG (n = 42). Complications from SG that warranted conversion included refractory GERD (40.5%), sleeve stenosis (31.0%), gastrocutaneous (16.7%), or gastropleural (7.1%) fistula, and gastric torsion (4.1%). The mean (SD) age was 47.2 years (11.4 years) and median BMI at the time of revision was 43.2 kg/mConversion of SG to RYGB is safe and technically feasible when performed for complications of SG or to enhance weight loss. This operation can be successfully performed laparoscopically with a low rate of conversion and reasonable complication profile.

Published
2018

9. Clinical and Echocardiographic Outcomes After Bariatric Surgery in Obese Patients With Left Ventricular Systolic Dysfunction

Author

Stacy Brethauer, Parag Patel, Mary Ellen Satava, James B. Young, João L. Cavalcante, Philip R. Schauer, and Amanda R. Vest

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, Population, Bariatric Surgery, 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, Ventricular Function, Left, Tertiary Care Centers, Ventricular Dysfunction, Left, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Weight loss, Internal medicine, Weight Loss, medicine, Humans, Obesity, Risk factor, education, Ohio, Retrospective Studies, education.field_of_study, Ejection fraction, business.industry, Stroke Volume, Retrospective cohort study, Recovery of Function, Stroke volume, Middle Aged, medicine.disease, Surgery, Transplantation, Treatment Outcome, Echocardiography, Heart failure, Cardiology, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

Background— Obesity is a risk factor for development of left ventricular systolic dysfunction (LVSD) and can complicate LVSD management, especially for individuals in whom cardiac transplantation is indicated. Bariatric surgery is increasingly recognized as a safe and effective intervention to achieve marked weight loss, but experience is limited in the LVSD population. Methods and Results— We retrospectively reviewed patients with obesity and left ventricular ejection fraction (LVEF) P =0.0005) for surgical subjects, but not for controls (+3.4%±10.5, P =0.056). Among surgical subjects, 11 patients had an LVEF improvement of >10%, whereas only 6 improved by >10% among nonsurgical controls. Conclusions— At experienced centers, bariatric surgery may be a safe and effective intervention for obese patients with LVSD. Bariatric surgery was associated with an improvement in LVEF, although the magnitude of change was on the cusp of clinical significance.

Published
2016

12. Decreasing Readmissions through Opportunities Provided (DROP): The First National Quality Improvement Collaborative from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)

Author

Stacy Brethauer, Elizabeth Berger, Kristopher Huffman, Jennifer Bradford, Teresa Fraker, Anthony Petrick, Cliff Ko, and John M. Morton

Subjects
03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, Quality management, business.industry, 030220 oncology & carcinogenesis, Medicine, Drop (telecommunication), 030211 gastroenterology & hepatology, Surgery, business, Accreditation
Published
2016

17. Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes: analysis of a randomized control trial comparing surgery with intensive medical treatment

Author

Sangeeta R, Kashyap, Deepak L, Bhatt, Kathy, Wolski, Richard M, Watanabe, Muhammad, Abdul-Ghani, Beth, Abood, Claire E, Pothier, Stacy, Brethauer, Steven, Nissen, Manjula, Gupta, John P, Kirwan, and Philip R, Schauer

Subjects
Blood Glucose, Gastric Bypass, Clinical Care/Education/Nutrition/Psychosocial Research, Bariatric Surgery, Lipid Metabolism, Diabetes Mellitus, Type 2, Gastrectomy, Glucagon-Like Peptide 1, Insulin-Secreting Cells, Weight Loss, Humans, Obesity, Insulin Resistance, Original Research
Abstract

OBJECTIVE To evaluate the effects of two bariatric procedures versus intensive medical therapy (IMT) on β-cell function and body composition. RESEARCH DESIGN AND METHODS This was a prospective, randomized, controlled trial of 60 subjects with uncontrolled type 2 diabetes (HbA1c 9.7 ± 1%) and moderate obesity (BMI 36 ± 2 kg/m2) randomized to IMT alone, IMT plus Roux-en-Y gastric bypass, or IMT plus sleeve gastrectomy. Assessment of β-cell function (mixed-meal tolerance testing) and body composition was performed at baseline and 12 and 24 months. RESULTS Glycemic control improved in all three groups at 24 months (N = 54), with a mean HbA1c of 6.7 ± 1.2% for gastric bypass, 7.1 ± 0.8% for sleeve gastrectomy, and 8.4 ± 2.3% for IMT (P < 0.05 for each surgical group versus IMT). Reduction in body fat was similar for both surgery groups, with greater absolute reduction in truncal fat in gastric bypass versus sleeve gastrectomy (−16 vs. −10%; P = 0.04). Insulin sensitivity increased significantly from baseline in gastric bypass (2.7-fold; P = 0.004) and did not change in sleeve gastrectomy or IMT. β-Cell function (oral disposition index) increased 5.8-fold in gastric bypass from baseline, was markedly greater than IMT (P = 0.001), and was not different between sleeve gastrectomy versus IMT (P = 0.30). At 24 months, β-cell function inversely correlated with truncal fat and prandial free fatty acid levels. CONCLUSIONS Bariatric surgery provides durable glycemic control compared with intensive medical therapy at 2 years. Despite similar weight loss as sleeve gastrectomy, gastric bypass uniquely restores pancreatic β-cell function and reduces truncal fat, thus reversing the core defects in diabetes.

Published
2013

18. 3. Metabolic Surgery and Control of Type 2 Diabetes

Author

Helen M. Heneghan, Shai Meron Eldar, Stacy Brethauer, and Philip R. Schauer

Subjects
medicine.medical_specialty, business.industry, Internal medicine, Metabolic surgery, Medicine, Type 2 diabetes, business, medicine.disease
Published
2012

20. Contributors

Author

Joseph B. Abdelmalak, Abby Abelson, Ahmed Absi, Edgar Achkar, David J. Adelstein, Talal Adhami, Kamal Adury, Anjali Advani, Feyrouz Al-Ashkar, Amjad AlMahameed, Antoine Amado, Sheila Armogida, Wendy S. Armstrong, Mercedes E. Arroliga, Alejandro C. Arroliga, Kathleen Ashton, Arman Askari, Natasha Atanaskova, Marjan Attaran, Federico Aucejo, Joseph Austerman, Robin Avery, H. Nail Aydin, David Barnes, John R. Bartholomew, Pelin Batur, Rachid Baz, Wilma Bergfeld, Deepak Bhatt, Swati Bharadwaj, Laura K. Bianchi, Allan Boike, Michael H. Bolooki, Brian Bolwell, Corinne Bott-Silverman, Andrew Boyle, Linda Bradley, William E. Braun, Yvonne Braver, Sorin J. Brener, Stacy Brethauer, Marie M. Budev, Matthew Bunyard, Carol Burke, Saud Butt, Leonard Calabrese, Charles Camisa, Darwin L. Caldwell, John Carey, William D. Carey, Karin Cesario, Nathaniel Cevasco, Jeffrey T. Chapman, Soumya Chatterjee, Michael C. Chen, Neil Cherian, Priya Chinnappa, Anuja Choure, Jeffrey Y. Chung, Gregory B. Collins, Edward C. Covington, Daniel A. Culver, Ronan Curtin, Mellar Davis, Steven Deitcher, Sevag Demirjian, Robert Dreicer, Thomas J. Dresing, Raed A. Dweik, Bijan Eghtesad, Julie A. Elder, Peter J. Embi, Kristin Englund, Serpil Erzurum, Ronan Factora, Kyrsten Fairbanks, Esteban Faith-Fernandez, Tatiana Falcone, Tommaso Falcone, Gary W. Falk, Suzanne R. Fanning, Richard Fatica, Omar Fattal, Michael Faulx, Elizabeth File, Maria Fleseriu, Fetnat Fouad-Tarazi, Adele Fowler, Robert Fox, Kathleen N. Franco, Thomas G. Fraser, Benjamin J. Freda, Katherine Freeman, John J. Fung, Jorge Garcia, Thomas R. Gildea, Joseph A. Golish, Anil Gopinath, Steven Gordon, Lisa Grandinetti, Adam Grasso, Brian Griffin, Richard Grimm, Rula A. Hajj-Ali, Philip Hall, Amir H. Hamrahian, Shannon Harrison, Teresa Hermida, José Hernández-Rodriguez, Robert Heyka, Gary S. Hoffman, Robert Hobbs, Sandra Hong, Byron Hoogwerf, Fred Hsieh, Julie Huang, M. Elaine Husni, Adriana G. Ioachimescu, Octavian C. Ioachimescu, Harry J. Isaacson, Carlos M. Isada, Naim Issa, Wael A. Jaber, Ron Jacob, Fredrick J. Jaeger, Fred Jaeger, Xian Wen Jin, Georges Juvelekian, Sangeeta Kashyap, Irene Katzan, Gurjit Kaur, Mani Kavuru, Thomas F. Keys, Sami Khalife, Mazen K. Khalil, Atul Khasnis, Esther S.H. Kim, Richard Kim, Alice Kim, R. Koelsch, Curry L. Koening, Ann R. Kooken, Shakuntala Kothari, Richard A. Krasuski, Robert Kunkel, Milton Lakin, David M. Lang, Steven P. LaRosa, Martin E. Lascano, Bret Lashner, Anthony K. Leung, Harry Lever, David S. Lever, Kerry H. Levin, Alan Lichtin, Oren H. Lifshitz, Li Ling Lim, Daniel Logan, Jennifer Lucas, Marina Magrey, Michael Maier, Donald Malone, Judith Manzon, Anjli Maroo, Manu Mathews, Steven D. Mawhorter, Mark Mayer, Ken Mayuga, Peter J. Mazzone, Mark S. McAllister, Kevin McCarthy, Kathleen Maksimowicz-McKinnonn, Adi Mehta, Atul C. Mehta, Tarek Mekhail, Charles M. Miller, Donald Moffa, Asma Moheet, Eamonn Molloy, Halle Moore, Thomas Morledge, Sherif B. Mossad, Preetha Muthusamy, David J. Muzina, Dileep Nair, Joseph Nally, Christian Nasr, Thomas P. Noeller, Gian M. Novaro, Saul Nurko, Robert S. O'Shea, Ravindran Padmanabhan, Velma L. Paschall, Lily C. Pien, Melissa Piliang, Ronnie Pimental, Emilio D. Poggio, Jeannette M. Potts, Leo Pozuelo, Gary W. Procop, Mohammed Qadeer, Christine Radojicic, Mohammed Rafey, Justin L. Ranes, Russell Raymond, Feza Remzi, Thomas Rice, Cristina Rodriguez, Jess Rowney, Camille Sabella, Ronald M. Sabecks, Mandi Sachdeva, Nancy Foldvary-Schaefer, Philip Schauer, Raymond Scheetz, Steven Schmitt, Martin Schrieber, Raul J. Seballos, Robert A. Schweikert, Mikkael A. Sekeres, Bo Shen, Robert W. Shields, Jr., Anita Shivadas, Laura Shoemaker, Nabin K. Shrestha, Rabin K. Shrestha, Bernard J. Silver, Rishi P. Singh, Vivek Singh, Mario Skugor, Stephen Smith, Edy Soffer, Firas Al Solaiman, Apra Sood, Brian R. Stephany, Tyler Stevens, Glen H.J. Stevens, James K. Stoller, David Streem, Patrick Sweeney, James F. Swiencicki, Alan Taege, Rachel M. Taliercio, Thomas Tallman, Jinny Tavee, Anthony Tavill, David Taylor, James S. Taylor, George E. Tesar, Holly L. Thacker, Karl Theil, Sharon Longshore Thornton, Kenneth J. Tomecki, Walton J. Tomford, Rebecca Tung, Marisa Tungsiripat, Allison Vidimos, Nicola M. Vogel, Jamile Wakim-Fleming, Teo Boon Wee, Christopher Whinney, Anna Wieckowska, Herbert P. Wiedemann, William Wilke, Justin G. Woodhouse, Bridget Wright, Mohamad Yamani, Kristine Zanotti, Claudia O. Zein, Robert Zimmerman, and Matthew J. Zirwas

Published
2010

21. Obesity

Author

Stacy Brethauer, Sangeeta Kashyap, and Philip Schauer

Published
2010

24. Minimally Invasive Bariatric Surgery

Author

Phillip R. Schauer, Bruce D. Schirmer, Stacy Brethauer, Phillip R. Schauer, Bruce D. Schirmer, and Stacy Brethauer

Subjects
Obesity--Surgery, Laparoscopic surgery
Abstract

'Minimally Invasive Bariatric Surgery'covers the full spectrum of laparoscopic weight loss surgery and the pathophysiology of obesity. The chapter authors, all currently operating experts in the field, cover the essentials of establishing a bariatric surgery program, including equipment needs, guidelines for training, and patient selection. The operative chapters discuss in full detail the surgical techniques and outcomes, including laparoscopic VGB, laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y, and laparoscopic malabsorption procedures. The text also tackles post-operative issues, such as complications, reoperation, plastic surgery after weight loss, nutritional issues, and pregnancy following obesity surgery. The text is graphically enhanced with over 175 full-color and 265 black and white images: surgical photos, anatomical drawings, operative technique illustrations and management algorithms.'Minimally Invasive Bariatric Surgery'enables clinicians to provide their patients with a viable solution to chronic obesity.

Published
2007

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